Efficient use of health care services in Barbados. Simple, fiscally-responsible changes that can make a difference

 The responsibility of the population.
In the setting of the privilege of free health care, it is the civic duty of every resident to take responsibility for their well being (physical & emotional) and discontinue the reckless choices fueling the costly NCD epidemic. Individuals must be made to face this naked truth with clarity. The current patriotic mood on the island makes this message put forth by a respected leader likely to pay dividends. There are ways to personalize the message such that a deeper insight is realized- e.g. most people want their children’s schools improved and would understand that money forced to be spent on preventable lifestyle illnesses is not available to be channeled into serious nation-building projects.

 Role of the QEH
The Island’s only tertiary care health care facility must be efficient/excellent at its highest purpose and must prioritize the needs of the more seriously ill patients over the desires of individuals in general.
If we do not satisfy individuals’ desires, we disappoint them.
If we do not satisfy ill patients’ needs, we FAIL them

The following ideas are put forward-:
1) Have every Head of department collate a list of clinical issues that come to their department that can be/should be managed in primary care/polyclinics (or even self-managed).

2) Have a deliberate/intentional approach to resource management with full acknowledgement of what is within the hospital’s capacity. The aim is to focus on what meaningfully impacts on patient outcome and avoid excesses that do not matter. E.g. A cardiac echo should be performed if it is critical to clinical decision-making as opposed to a case where it is “nice to have”.

3) The junior doctors…the work-horses of the hospital need to be valued as “units of talent”. High standards of competence/excellence must be set for them and in return their work should supported. One of the frustrations they site is having to struggle to get necessary radiological investigations. The solution would be to have a daily standard slot for ward cases in the morning and out-patient cases in the afternoon. Also more communication is needed to avoid unnecessary investigation requests.

4) Seek support from respected NGO’s to assist in areas that are important but lacking at QEH. Two such areas are palliative care medicine and psychological services. Both these services if available to QEH patients would prevent unnecessary hospital visits and admissions. E.g. Several relatives of terminally ill patients are uncomfortable with the prospect of patients dying at home but have chosen with the support of the Barbados Association of Palliative Care to keep their loved ones at home. Psychological counselling is necessary for patients with stress-related somatic symptom disorders. This group of patients can be extremely costly to a health-care system prompting multiple consultations and the request for expensive investigations in search for what appears to be an elusive diagnosis- mainly in an attempt to reassure the patients that their complaints are being taken seriously.

5) Expedite the transfer of the “Elderly for care” and “Young for care” to district hospitals. It is unreasonable to compromise the bed stock available to seriously and acutely ill persons who require advanced care.
Long term, I would propose that the Geriatric Hospital be outfitted to allow basic medical care for the elderly so that for example an elderly Alzheimer’s patient can be admitted there for treatment of a pneumonia. Such a patient is not a candidate for advanced therapy like ventilation so care at QEH should not be necessary. The elderly who just require nursing/social care should be transferred from the Geriatric Hospital to district hospitals. If a client of the district hospital then needs intervention for an intercurrent medical illness that does not require the advanced level of care of QEH, they can be managed at the Geriatric Hospital and returned to the district hospital once stable.

6) Address the issue of individuals pursuing unmerited sick leave (for 1 year) and disability. This is a frustrating subset of QEH patients engaging in a willful attempt to simulate illness for secondary gain. The Honorable Prime Minister Mia Mottley mentioned that the government would not tolerate individual’s attempting to deceive the Barbados Revenue Authority- I believe the term used was “making mock sport”…similarly I think a simple forceful statement acknowledging that it is well known to authorities that individuals attempt to deceive the NIS will discourage some offenders who are just “trying ah ting”. It would be very noble if the Unions could be supportive in this area.

7) User fees are long overdue. They should be affordable and waived in the subset of individuals who are indigent. Most individuals who receive free health care at QEH buy costly, unproven, amazing complementary medicines.

Cindy Flower, medical doctor.